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Wednesday, January 13, 2010

Still Selling Snake Oil or Non-insurance Health Insurance Options

One of the providences of blogging is that I get more interesting solicitations. I wouldn't call them spam since they tend to include my name, flatter me about my importance in the blogosphere, and offer their goods. Actually, it's market research coming to me which makes it useful.

From talking with insurance agents, I've learned that you can buy insurance for anything. For example, you can buy a policy for cancer only that would provide payments for medical bills or give you a lump sum of money to either spend on medicine or the most debacherous acts that you ever fantasized about.

In the individual insurance market, there's also some options that look like insurance but are not technically health insurance. Kind of like the Aflac duck that looks like a duck, walks like a duck, but quacks like your angry paranoid uncle during the State of the Union address. I learned about these through the unctuous solicitations through my blog, unsolicited phone calls from private numbers, or just keeping my eyes and ears open. However, right now, readers are probably checking out my use of a word "unctuous" that I still remember from SAT preparation! Before I digress anymore, here are the 4 individual insurance options that aren't technically insurance but might work or in most cases won't work:

1. No Insurance Club or All the primary care doctor visits you want for an annual fee: No Insurance Club found my blog and sent me some information about their services. From reading that information, I realized that the No Insurance Club marketing team doesn't know the difference between Medicaid or Medicare. I don't suppose that they should have to know the difference since their focus is on the absence of insurance (but hopefully not the absence of fact checking).

No Insurance Club offers 12 primary care visits/year with a doctor that is a participant in their plan and some lab testing for an annual fee. No hospital, no Emergency Room, no drugs, and nothing if your doctor doesn't want to participate with the No Insurance Club. Some large primary care practices offer similar arrangements as this is becoming more common. It's not a bad value since a doctor visit generally costs $100-$150. A $300 annual fee would pay for itself with 2-3 visits and will ensure that the doctor will see you even if you don't have insurance.

My biggest concern with No Insurance Club and other non-insurance options, is that their name is misleading. It should be called Unlimited Doctor or Annual Physician Membership since it has nothing to do with insurance. It's like me selling membership in the No Calories Cake Club. However, it does provide great access to primary care for those who just want to be able to see a doctor whenever they need one and don't need or can't afford health insurance.

2. Mini, Limited, or Defined Medical Benefit Plans: These are the plans whose representatives cold call me at work. While most insurance plans define their benefits by what you will have to pay for services (like you pay a $100 for a colonoscopy and the health insurance plan pays the rest), these plans define their benefits by what they will pay (they will pay the doctors $100 for the colonoscopy and you pay the rest). They often have limits to how much they'll ever pay out in services.

Purchasing these plans should be a calculated decision. Since they will very clearly describe what they'll pay, you should take out a calculator, add up what services you will use, subtract the cost of the plan, and see if it's worth it. Their benefit should be fairly clear as they generally cover the more common services. I could see this being valuable for young children who typically go to the doctor every few months, get immunizations, will likely get a few colds or the flu, probably fall down and cut something open, or eat something they shouldn't. For someone who gets it just in case something happens, these won't be helpful since they don't cover extensive hospitalizations or surgeries.

These plans also tend to look like health insurance so they are also fairly misleading. From my cake example above, I would call these the Chocolate Cake Plan with a footer that the cake contains no chocolate, sugar, or butter.

3. Discount Medical Plans or the Costco Plan: Getting an insurance plan at Costco should either really appeal or really frighten (especially for those who saw the movie Idiocracy) someone. However, discount medical plans are basically like Costco plans where you get discounted services at participating doctors and facilities. The discounts are the same as what insurance companies typically negotiate with providers. Just like Costco can get you a pound of cheese for under $10, a discount plan might get you 15 minutes with your doctor for less than $100.

This is another calculated benefit as you should be able to think about often you're going to need to go to the doctor for this plan to be worth it. The more you use it, the more you save, but that is not a good thing with health care and can get very expensive. I also don't know if doctors who typically don't see patients without insurance or require deposits would waive those requirements for a discount program. I suspect not but anyone interested in a discount plan should ask.

Discount medical plans have become heavily regulated and have the most straight forward and clear explanations of what they are and what they are not. You're getting some real cake but it's only a sliver.

4. Short-term Medical Plans: This is truly the "What if you get hit by a bus" insurance plan. It is actually a type of insurance plan so it almost doesn't belong in this category but it's a fairly good option. For about $1/day, you will get covered for a major hospitalization or surgery. It won't cover routine care and there is a clause for pre-existing conditions that vary by state. In Oregon, the pre-existing clause goes back 5 years but in Idaho it's only 6 months.

Given they're called short-term medical, it's fairly straight forward that it's a temporary plan. I have read about some people getting confused by the description but I think that it's more straight forward than Mini or Limited Medical plans. For my cake analogy, with short-term medical, you either get nothing or you get to eat the entire cake. Burp!

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